Editorial Board

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Tumor fibroso solitario de la glándula tiroides con extensión intratorácica

El tumor fibroso solitario (TFS) es una neoplasia mesenquimal de células fusiformes infrecuente descrita inicialmente en la pleura pero con localización reconocida en otros sitios. El TFS de la glándula tiroides (TFST) es aun más raro. Se describe el caso de una mujer de 65 años de edad, con masa cervical de crecimiento progresivo, a tal punto que ya la masa se hacía notable en parte inferior de su cuello, siendo este el único síntoma narrado. La paciente presentaba una gran masa tiroidea en el lóbulo derecho con extensión intratorácica. Se practicó hemitiroidectomia derecha (paciente tenia historia previa de resección del lóbulo tiroideo izquierdo por lesión benigna) Total, además de toracotomía endoscópica por la extensión de la masa la cual en la tomografía contrastada, se originaba en el lóbulo tiroideo derecho y descendía paralelo a la columna dorsal desplazando a la tráquea y el esófago. La patología reportó un tumor de 15 centímetros, con células fusiformes y patrón de crecimiento hemangiopericítico sin pleomorfismo, atipia, mitosis o necrosis. Luego de practicar diferentes estudios y marcadores tumorales, de todos estudios fueron positivos CD34, Bcl2, CD99 y vimentina. Se diagnosticó tumor fibroso solitario de glándula tiroides. El nervio vago derecho fue lesionado en la cirugía, actualmente está en terapia de voz. Al momento actual casi seis meses luego de su cirugía, no se documenta recidiva tumoral.

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Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm initially described as spindle cells in the pleura but recognized location elsewhere. The TFS thyroid gland (TFST) even infrequent. A case of a 65 years old woman with progressive growth of a right cervical mass without associated symptoms described other than cosmesis is described . The patient had a thyroid mass in the right lobe with intrathoracic extension. A right Hemi thyroidectomy and thoracotomy for the extent of the mass was performed. Pathology reported a 15 cm tumor with spindle cell and growth pattern hemangiopericitic without pleomorphism, atypia, mitosis or necrosis. Immunohistochemistry was positive for CD34, Bcl-2, CD99 and vimentin, making the diagnosis of solitary fibrous tumor of thyroid gland. The patient's right Vagus nerve was injured intraoperatively and she is currently under voice therapy. Currently now, almost six months after her surgery she is free of disease.

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Revista de Otorrinolaringología 2017

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Diseño y evaluación de las propiedades antibacterianas de un prototipo de molde de audífono que incorpora cobre en su manufactura

Introducción: La otitis externa infecciosa es una consulta otorrinolaringológica frecuente en usuarios de audífonos. Las propiedades antibacterianas descritas del cobre, han motivado el desarrollo de aplicaciones clínicas de este metal. Objetivo: Evaluar la capacidad antibacteriana de moldes de audífonos manufacturados con polímeros sensible a luz UV, silicona y acrílico que incorporan cobre metálico, en un sistema experimental in vitro. Material y método: Se diseñaron moldes de audífonos con y sin cobre, que fueron inoculados con distintas concentraciones de microorganismos (S aureus y P aeruginosa), para luego determinar el porcentaje de adherencia bacteriana a distintos tiempos de contacto (4, 8 y12 horas). Resultados: Existió reducción significativa en la adhesión bacteriana a los moldes con cobre respecto a aquellos sin cobre, independiente del material, del tipo de microorganismo y del inóculo bacteriano. Discusión: La disminución en la adherencia bacteriana en los prototipos con cobre, puede atribuirse a su actividad inhibitoria sobre los microorganismos en función de su concentración y el tiempo de contacto, ejerciendo su efecto por difusión a través de los distintos materiales. Conclusión: Con estos resultados, se hace necesario el desarrollo de estudios clínicos enfocados en comprobar si el uso de audífonos con cobre disminuyen las otitis externas de origen infeccioso.

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Introduction: External otitis of infectious etiology among hearing aid users is a common motive of otolaryngology consultation. Antibacterial properties described copper, they have motivated the development of clinical applications of this metal. Aim: Evaluate the antibacterial capacity of copper-based ear molds manufactured with different materials such UV sensitive polymers, silicone and acrylic incorporating metallic copper, in an experimental system in vitro. Material and method: Ear molds with and without copper, were inoculated with different concentrations of microorganisms (S aureus and P aeruginosa) and determine the percentage of bacterial adherence to different contact times (4-8 and 12 hours). Results: There was significant reduction in bacterial adhesion to copper molds than those without copper, independent of the material, the type of microorganism and the bacterial inoculum. Discussion: The decrease in bacterial adherence on prototypes with copper, can be attributed to inhibitory activity on microorganisms depending on their concentration and contact time, exerting its effect by diffusion through the various materials. Conclusion: With these results, is necessary the development of clinical studies focused on checking whether the use of hearing aids with copper decreases external otitis of infectious origin.

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Estudio epidemiológico descriptivo de pacientes hospitalizados en el Servicio de ORL del Hospital Clínico de la Universidad de Chile entre los años 2007 y 2014

Introducción: Las enfermedades de origen otorrinolaringológico (ORL) tienen una elevada prevalencia en atención primaria de salud, sin embargo, la información epidemiológica en pacientes hospitalizados es bastante escasa. Objetivo: Obtener características demográficas y prevalencia de enfermedades en los pacientes hospitalizados del Servicio de ORL del Hospital Clínico de la Universidad de Chile (HCUCh). Material y método: Estudio de tipo descriptivo y retrospectivo, llevado a cabo en el Servicio de ORL del HCUCh, donde se revisaron los registros electrónicos, existentes de grupos relacionados a diagnóstico (GRD) de egresos, entre los años 2007 y 2014. Resultados: Se incluyeron 7.353 egresos, con un promedio de edad de los pacientes de 28,24 años. La causa de hospitalización más frecuente fue la patología de faringe. Del total de los egresos 87,88% presentaron una intervención quirúrgica donde la amigdalectomía con adenoidectomía alcanzó el 15,7% de las cirugías realizadas. Conclusión: Este estudio nos entrega información epidemiológica sobre los pacientes hospitalizados en un servicio de ORL de un hospital de referencia a nivel nacional.

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Introduction: Diseases ofotolaryngology (ENT) origin have a high prevalence in primary health care, however, the epidemiological information on hospitalized patients is almost null. Aim: To obtain demographic and disease prevalence information in hospitalized patients of the ENT Department at the Hospital Clínico de la Universidad de Chile (HCUCh). Material and method: A descriptive and retrospective study, was carried out at the ENT department of the HCUCh, reviewing existing records of diagnostic related groups (GRD) for discharges between 2007 and 2014. Results: We review a total of 7353 discharges, with an average age of patients of 28.24 years. The most frequent cause of hospitalization was pharynx pathology. An 87.88% of discharges had surgery performed, where tonsillectomy with adenoidectomy reached 15,7% of the total. Conclusion: This study provides us with epidemiological information on patients hospitalized in an ENT department in a nationwide referral hospital.

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Comparación de las amplitudes y latencias de la onda V del potencial evocado auditivo de tronco cerebral obtenidas a través de estímulos clic y CE-Chirp®

Introducción: El potencial evocado auditivo de tronco cerebral (PEATC) se ha convertido en un procedimiento estándar dentro de la evaluación audiológica. Durante décadas, el estímulo más utilizado ha sido el clic, sin embargo, últimamente se ha propuesto la utilización de estímulos de frecuencia modulada (chirp) para obtener resultados más eficientes. Objetivo: Comparar las amplitudes y las latencias de la onda V del PEATC obtenidas a través de estímulos clic y CE-Chirp® a distintas intensidades. Material y método: Se realizó un estudio de tipo cuantitativo, no experimental, transversal y descriptivo en 17 sujetos a los que se evaluó con un PEATC utilizando estímulos clic y CE-Chirp®. Resultados: Se obtuvieron mayores amplitudes de onda Vpara estímulos CE-Chirp® que para clic, en todas las intensidades evaluadas (80, 60, 40,30 y 20 dBnHL). Se obtuvieron menores latencias en la onda Vpara estímulos CE-Chirp® solo a 80 y 60 dBnHL, mientras que en el resto de las intensidades se obtuvo menores latencias con estímulos clic. Conclusiones: Existen diferencias significativas entre las latencias y amplitudes de la onda V obtenidas con estímulos clic y CE-Chirp®. Mientras los estímulos CE-Chirp® aportan en rapidez en el examen y en la búsqueda del umbral electrofisiológico más preciso, los estímulos clic serían los adecuados al momento de realizar un estudio de topodiagnóstico.

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Introduction: The auditory brainstem response (ABR) has become a standard procedure in the audiological evaluation. For decades the most widely used stimulus was the click, but recently the use of chirp stimulus has been proposed for obtain more efficient results. Aim: To compare the amplitudes and latencies of wave V of ABR obtained through click and CE-Chirp® stimuli at different intensities. Material and method: A quantitative, not experimental, transversal and descriptive study was conducted with 17 subjects who were evaluated with ABR using click and CE-Chirp® stimuli. Results: Wave V larger amplitudes were verified for stimulus CE-Chirp®, in all the evaluated intensities (80, 60, 40, 30 and 20 dBnHL). Shorter latencies of wave V were obtained for CE-Chirp® stimuli only at 80 and 60 dBnHL, while it was found that the remaining intensities showed lower latencies with click stimuli. Conclusions: There are significant differences between latencies and amplitudes of the wave V obtained with CE-Chirp® and click stimuli. While the CE-Chirp® stimuli provides faster results for most accurate electrophysiological threshold, click stimuli would be appropriate to conduct site of the lesion testing.

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Experiencia clínica en tiroidectomía total del Servicio de Otorrinolaringología y Cirugía de Cabeza y Cuello Hospital Guillermo Grant Benavente

Introducción: La tiroidectomía es una de las cirugías más frecuentes realizadas en cabeza y cuello. Existen escasos reportes de experiencia en tiroidectomías en servicios de otorrinolaringología en Chile. Objetivo: Analizar la experiencia clínica con las tiroidectomías totales realizadas en el Servicio de ORL y Cirugía de Cabeza y Cuello de nuestro hospital. Material y método: Estudio descriptivo retrospectivo. Revisión de fichas clínicas de pacientes sometidos a tiroidectomías totales (TT) entre los años 2010 y 2014 en nuestro servicio. Resultados: Se realizaron 271 tiroidectomías totales. La indicación más frecuente fue por tamaño (51%). Los diagnósticos más frecuentes fueron carcinomas papilares (46%) e hiperplasia folicularcoloidea (37%). Se presentaron lesiones transitorias del nervio laríngeo recurrente en 2,9%, y lesiones persistentes en 2,5%. Hipocalcemia transitoria se presentó en el 25% de los pacientes. Discusión: Nuestra serie presenta resultados concordantes con la literatura, presenta una baja tasa de complicaciones, las cuales se observan principalmente en pacientes con vaciamiento cervical y/o en que se observaron 2 o menos paratiroides. Conclusiones: La tiroidectomía total es una técnica quirúrgica segura y nuestra experiencia presenta resultados concordantes a los publicados en la literatura internacional.

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Introduction: Thyroidectomy is one of the most common surgeries performed in head and neck. There are few reports of experience in thyroidectomy in otolaryngology services in Chile. Aim: To analyze the clinical experience with total thyroidectomy performed in the service of ENT and Head and Neck Surgery of our hospital. Material and method: Retrospective descriptive study. Review of medical records of patients undergoing total thyroidectomy (TT) between 2010 and 2014 in our service records. Results: A total of 271 thyroidectomy were performed. The most frequent indication was size (51%). The most frequent diagnoses were papillary carcinomas (46%) and follicular colloid hyperplasia (37%). We found 2.5% of transient recurrent laryngeal nerve injury and 2.9% had persistent lesions. Transient hypocalcemia occurred in 25% of patients. Discussion: Our series shows good agreement with literature, it has a low rate of complications, which are mainly seen in patients with neck dissection and/or observed 2 or less parathyroid during surgery. Conclusions: Total thyroidectomy is a safe surgical technique, and our experience shows consistent results to those reported in international literature.

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Prácticas audiológicas en Chile: encuesta online para tecnólogos médicos mención otorrinolaringología

Introducción: A nivel internacional existen diversas instituciones que sugieren los estándares mínimos para la realización de los procedimientos audiológicos. Esto tiene como objetivo asegurar la calidad de las evaluaciones auditivas. Esto resulta de importancia en Chile debido a la implementación de programas de salud auditiva en el marco de las garantías explicitas de salud (GES). Objetivo: Documentar las prácticas comunes dentro de Tecnólogo Médico c/m Otorrinolaringología con la finalidad de obtener información para la creación y desarrollo de protocolos estandarizados para la evaluación audiológica. Material y método: Se aplicó un cuestionario de 38 preguntas distribuido a partir de una plataforma online a través de redes sociales y por correo electrónico a los socios de la Sociedad Chilena de Audiología y Otoneurología. Resultados: Se analizaron 121 encuestas finalizadas. Sobre el 70% de los encuestados que ejerce en la zona central. Procedimientos como audiometría de tonos puros, impedanciometría y logoaudiometría son frecuentemente realizados dentro de los encuestados. Estos procedimientos son realizados de acuerdo a lo sugerido dentro de estos profesionales. Conclusión: Existe una alta adherencia de las conductas sugeridas por instituciones internacionales para la realización de los procedimientos más comunes realizados en clínica por parte de los Tecnólogos Médicos c/m Otorrinolaringología.

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Introduction: Internationally several institutions suggest minimum standards for the conduct of audiological procedures. This aims to ensure the quality of auditory assessments. This is of importance in Chile due to the implementation of hearing programs under the Explicit Health Guarantees (EHG). Aim: To document common audiological practices of Medical Technologist in order to development standardized protocols for audiological assessment. Material and method: An online-based questionnaire with 38 questions was provided through social networks and by email to members of the Chilean Society of Audiology and Otoneurology. Results: One hundred and twenty one completed surveys were analysed. About 70% of respondents work in the central region of Chile. Procedures such as pure audiometry, tympanometry and speech audiometry were frequently performed by respondents. Respondents followed international guidelines. Conclusion: There is a high adherence to international recommendations when conducting the most common procedures performed in audiology clinics in Chile by the Medical Technologists who responded to the survey.

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Tumor neuroectodérmico primitivo de cavidad nasal

Los tumores neuroectodérmicos primitivos son tumores muy infrecuentes. Derivan de células embrionarias de la cresta neural, y comparten características con los sarcoma de Ewing extraóseos. Se presentan habitualmente en niños y adultos jóvenes, su ubicación más frecuente es en la región toracopulmonar, abdomen y extremidades. Son tumores que presentan una agresividad importante, lo que condiciona un pronóstico sombrío. La ubicación en fosas nasales-cavidades perinasales es anecdótica, existiendo el reporte de tan sólo un caso en la literatura mundial de ubicación en cavidad nasal.

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Primitive neuroectodermal tumors are rare malignancies arising from embryonic neural crest cells. They share characteristics with extraosseous Ewing sarcoma. They usually occur in children and young adults and the most common location is the thoracopulmonary region, abdomen and extremities. These tumors have significant aggressiveness, which determines their poor prognosis. The location in nasal fossa-paranasal cavities is anecdotal. Until now only one previous case has been reported in the located in the nasal fossa.

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Glomangiopericitoma: Reporte de un caso

El glomangiopericitoma es un tumor nasosinusal extremadamente raro, más frecuente en pacientes de edad avanzada y en mujeres. Si bien su etiopatogenia es desconocida, se reconocen ciertos factores predisponentes tales como hipertensión arterial, embarazo, trauma y uso de corticoides. Para su diagnóstico, resulta necesario recurrir tanto a estudio por imágenes como a la histología y técnicas de inmunohistoquímica. Microscópicamente se caracteriza por un prominente crecimiento perivascular de células uniformes ovales o fusiformes, dispuestas en fascículos cortos intercalados con capilares de diámetros variables ramificados en "asta de ciervo" y presenta inmuno-rreactividad positiva para actina, factor XIII-A y vimentina principalmente. Clínicamente este tumor presenta un comportamiento generalmente benigno, pero con una elevada tasa de recurrencia. Presentamos el caso de una mujer de 71 años, con antecedentes de hipertensión arterial, que acudió a nuestro centro por rinorrea purulenta y epistaxis unilateral derecha de 5 años de evolución. Al examen se observa masa polipoidea en fosa nasal derecha con abundante vascularización, sin otros hallazgos al examen físico. La lesión es resecada en su totalidad mediante cirugía endoscópica. El estudio histológico e inmunohistoquímico son compatibles con glomangiopericitoma. La paciente evoluciona con remisión de su sintomatología y a los dos meses desde la resección no ha presentado evidencias de recurrencia.

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Glomangiopericytoma is an extremely rare sinonasal tumor, more common among elderly and women. Although its etiology and pathogeny are unknown, there are certain predisposing factors, such as arterial hypertension, pregnancy, trauma and corticosteroids. To diagnose this tumor, it is necessary imaging, histopathologic and inmunohistochemical studies. At the microscopic study, it is characterized by a prominent perivascular growth of oval-shaped or fusiform cells, arranged in short fascicles separated by capillary vessels of variable diameters, with staghorn-like ramifications, and lmmunohistochemistry positive mainly for actin, XIII-A factor and vimentin. Clinically, this tumor has a generally benign behavior, but with high recurrence percentage. We present the case of a 71 years old woman, with history of hypertension, who present in our center with a 5 years history of purulent rhinorrhea and right unilateral epistaxis, at the physical exam there is a polypoid mass in the right nasal fossa with rich vascularization, with no other findings. This tumor was resected entirely with endoscopic surgery. Histology and immunohistochemistry were compatible witch gomangiopericytoma. The patient evolve with remission of her symptoms and with no signs of recurrence at two-month follow-up.

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Plasmocitoma extramedular del tabique nasal: Reporte de un caso y revisión bibliográfica

Los plasmocitomas son tumores malignos caracterizados por proliferación anormal de células plasmáticas monoclonales. Éstos pueden originarse tanto en hueso como en tejidos blandos, denominados plasmocitomas óseos solitarios y plasmocitomas extra-medulares (PEM), respectivamente. Estos últimos representan menos del 1% de toda la patología maligna de cabeza y cuello, sin embargo, el reporte de estos casos resulta provechoso frente a la poca casuística al respecto. Presentamos el caso de plasmocitoma extramedular del septo nasal en un varón de 74 años con dificultad respiratoria nasal progresiva y frecuente epistaxis del lado izquierdo. A la especuloscopía nasal se observó en el vestíbulo una elevación tumoral de superficie lisa, grisácea, sésil. La biopsia mostró que era un plasmocitoma. Estudios posteriores descartaron la presencia de mieloma múltiple. Esto confirmó el diagnóstico de PEM. La masa fue completamente disecada, se indicó radioterapia y el paciente no tuvo adherencia al tratamiento. Sobre el mismo lecho al año siguiente reaparece lesión de similares características. Conclusión: Plasmocitoma extramedular del tabique nasal es una entidad rara, de una larga historia natural y que representa un desafío diagnóstico y terapéutico. Dependiendo de la resecabilidad de la lesión, la terapia combinada mediante cirugía y radioterapia es el tratamiento de elección.

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Plasmacytomas are malignant tumors characterized by abnormal proliferation of monoclonal plasma cells. They may originate in bone and soft tissue , called solitary bone plasmacytoma and extramedullary plasmacytomas (EMP) respectively. The latter represents less than 1% of all malignant disease of the head and neck, however, the report of these cases it is useful to cope with the shallow casuistics thereon. We report a case of EMP of the nasal septum in a man of 74 years with progressive nasal breathing difficulties and frequent epistaxis on the left side. A nasal speculoscopy was observed in tumor lift lobby smooth, gray, sessile surface. The biopsy showed it was a plasmacytoma. Subsequent studies reject the presence of multiple myeloma. This confirmed the diagnosis of EMP. The mass was completely dissected, radiation therapy is indicated and the patient had no adherence. Upon the same place a similar injury returns. Conclusion: Septum extramedullary plasmacytoma is a rare entity of a long natural history and represents a diagnostic and therapeutic challenge. Depending on the resectability of the lesion, combination therapy with surgery and radiation therapy is the treatment of choice.

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Presencia de la celdilla supra-órbito-etmoidal: Revisión de la literatura a partir de un caso

La celdilla supra-órbito-etmoidal es una variación anatómica que se presenta con diferente frecuencia para las distintas poblaciones. Representa un desafío al realizar cirugía endoscópica funcional del seno frontal debido a que su presencia dificulta el drenaje adecuado del receso del frontal mismo y puede ser confundida con el seno. La celdilla supra-órbito-etmoidal presenta relaciones espaciales constantes con la arteria etmoidal anterior, sirviendo como marcador anatómico confiable para el abordaje quirúrgico. Se destaca la importancia de considerar la presencia de tabiques óseos en el seno frontal en el estudio imagenológico que puedan sugerir la presencia de la celdilla supra-órbito-etmoidal. Se presenta el caso clínico de un paciente que consulta por proptosis del ojo derecho debido a un proceso expansivo por mucocele localizado en dicha variante anatómica.

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The supraorbital ethmoid cell its an anatomical variation with different frecuency for diverse populations. It represents a challenge for the endoscopical functional :surgery of the frontal sinus. The supraorbital ethmoid cell presents an estable anatomical relationship with the anterior ethmoidal artery, serving as a dependable anatomical marker for the surgical approach. We stand out the importance to consider the presence of bony septations in the frontal sinus that might suggest the presence of the supraorbital ethmoid cell. We introduce a clinical case from a patient who had an expansive process from a mucocele in the supraorbital ethmoid cell.

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Rinosporidiosis nasal: Reporte de un nuevo caso y revisión de la literatura

La rinosporidiosis es una enfermedad granulomatosa rara producida por el microorganismo Rhinosporidium seeberi. A pesar de ser considerada una infección endémica en algunas zonas de Asia, en nuestro país es una enfermedad extremadamente rara. Se presenta el caso clínico de un escolar de 10 años que consulta por aumento de volumen en fosa nasal izquierda de 1 mes de evolución, de crecimiento progresivo, con epistaxis autolimitada, presentando al examen físico una lesión polipoídea, en la cual, no existiendo sospecha previa, se determinó mediante histopatología la presencia de rinosporidio-sis. Se discute la epidemiología de la enfermedad, sus mecanismos de diseminación, alternativas de tratamiento y principales complicaciones.

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Rhinosporidiosis is a rare granulomatous disease produced by the microorganism Rhinosporidium seeberi. Despite being considered an endemic infection in some areas of Asia, in our country it is an extremely rare disease. We present the case of a 10 year-old boy who consult for increased volumen in the left nostril of 1 month evolution, with progressive growth, self-limited epistaxis, and a physical examination with a polypoid lesion, in which there were no prior suspicion, histopathology determined the presence of rhinosporidiosis. Epidemiology of the disease, its dissemination mechanisms, treatment options and major complications are discussed.

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Traqueostoma persistente: Cierre con colgajo invertido. Reporte de tres casos clínicos y revisión de la literatura

El traqueostoma persistente es la complicación tardía más frecuente asociada al uso de traqueostomía. Se reportan tres casos de pacientes que se les realizó un cierre exitoso del traqueostoma persistente mediante técnica de cierre primario por planos con colgajo invertido. Las ventajas del método utilizado son que representa una alternativa simple, susceptible de realizar con anestesia local y de manera ambulatoria, con excelentes resultados estéticos, mejorando significativamente la calidad de vida de estos pacientes.

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Persistent tracheostoma is the most common late complication associated with the use of tracheostomy. We report three cases in which patients underwent a successful closure of persistent tracheostoma using primary closure in layers with inverted flap technique. The advantages of this method are that it represents a simple alternative and is able to be performed under local anesthesia on an outpatient basis, with excellent aesthetic results, significantly improving the quality of life of these patients.

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Anatomía, fisiología y rol clínico de la corteza vestibular

El sistema vestibular, mediante sus órganos periféricos, nos permite procesar correctamente los cambios de aceleración angular de la cabeza y lineal del cuerpo y así permitirnos una correcta orientación en el espacio. Esta información sensorial es dirigida hacia los núcleos vestibulares y desde aquí se comunica con los núcleos óculo-motores y estructuras del tálamo a través de tractos ascendentes del tronco encefálico. Posteriormente la información se dirige hacia centros subcorticales y corticales de naturaleza eminentemente multisensorial. La naturaleza y función de estas estructuras es controversial. En esta revisión se abordan los principales conceptos y descubrimientos a nivel de investigación básica y clínica del procesamiento cortical generado por estimulación de tipo vestibular.

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The vestibular system, thanks to its peripheral organs, allows us to properly process the angular head movements and linear acceleration in order to give us a proper orientation in space. The information from these sensory inputs is routed to the vestibular nuclei and thence ascending tracts of the brainstem, which communicate with the oculomotor nuclei of the thalamus and structures. Then the information goes to subcortical and cortical centers, which are eminently multisensory nature. The nature and function of these structures are controversial. In this review the main concepts and discoveries at the level of basic and clinical research generated cortical processing of vestibular stimulation are addressed.

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Carcinoma basocelular metastásico

El carcinoma basocelular es la neoplasia con mayor incidencia a nivel mundial. Es de crecimiento lento y localmente agresiva pero posee un potencial metastásico extremadamente bajo, que se estima entre 0,0028% y 0,5%. El objetivo de este trabajo es mostrar la experiencia de una institución con el manejo de esta enfermedad metastásica. Estudio descriptivo retrospectivo de los pacientes con carcinoma basocelular metastásico tratados en el Instituto Nacional del Cáncer, entre julio 2004 y julio 2015. Se realizó una revisión de la literatura. Se evidenciaron 3 casos con esta enfermedad poco habitual en un plazo de 11 años. Un paciente falleció a los 42 meses de seguimiento. Hay 2 pacientes aún en control, uno de ellos lleva 29 meses de seguimiento y actualmente tiene enfermedad metastásica pulmonar, y el último paciente lleva 92 meses de seguimiento libre de enfermedad. El carcinoma basocelular metastásico, es una entidad poco frecuente por lo que todos los que nos vemos involucrado en su manejo debemos mantenernos alerta para una pesquisa oportuna. La cirugía asociada a la radioterapia siguen siendo los pilares del tratamiento. Esta patología debiera manejarse en centros de referencia a nivel nacional.

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Basal cell carcinoma is the most frequent neoplasm worldwide. It's a slow growing and locally aggressive tumor, but it has a metastatic potential estimated between 0,0028 and 0,5%. The purpose of this study is to show the experience of a center in the management of this metastatic disease. Descriptive retrospective study of patients with metastatic basal cell carcinoma treated at the Instituto nacional del cancer from July2004 to July 2015. A revision of the literature was also made. 3 cases with this unusual disease during an 11 years period. The first one died at 42 months of follow up. There are 2 patients on follow up, 1 of them has lung metastatic disease after 29 months of follow up, and the last one is free of disease with 92 months of follow up. Metastatic basal cell carcinoma is an unusual entity, thus everyone that is involved in it's treatment, must be aware of this in order to do an early diagnosis. Surgery associated to radiotherapy are the mainstays of treatment. This disease should be managed on national referral centers.

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Enmascaramiento clínico: Una revisión de la literatura

Son diversos los métodos planteados para aplicar enmascaramiento, de esta forma es necesario revisar la literatura en búsqueda de consenso. Se revisaron críticamente los métodos utilizados y recomendados por la literatura y sociedades internacionales, en torno a la aplicación de enmascaramiento. Se consultó entre agosto y noviembre de 2015 en PUBMED, SciELO y Google Scholar por estudios acerca de métodos de enmascaramiento utilizados en audiometría. También se revisaron las guías de organizaciones internacionales y lo publicado en libros relacionados con el área de audiología. El método de "La Meseta" es el más referenciado, siendo modificado posteriormente. Existen variaciones en criterios de atenuación interaural, necesidad de enmascaramiento, enmascaramiento inicial, incrementos para obtener la meseta y niveles del efecto de oclusión. Se concluye que la literatura muestra diferencias al momento de decidir cuándo enmascarar y cómo hacerlo. No obstante, se puede establecer criterios comunes en relación a los niveles de atenuación interaural, cuándo enmascarar, valores de efecto de oclusión y metodología. El método de "La Meseta" sigue siendo el más recomendado. La modificación realizada por Yacullo es la más referenciada y recomendada en la literatura actual.

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Adequate use of masking is key in the correct diagnosis of hearing loss. Various methods are suggested regarding the application of clinical masking, hence the need to review literature in order to reach a consensus. To critically review the specialized literature and international societies' recommendations regarding clinical masking. From August to November 2015, PUBMED, SciELO and Google Scholar articles on clinical masking methods used in tonal audiometries were consulted, as well as international organization guidelines, and literature in the area of Audiology. Hood's plateau method, later revised, received the most references. The modified versions consider the number of increments needed to determine the true threshold, and the occlusion effect. Optimized methods show the variations regarding interaural attenuation, need for masking, initial masking level, increments to reach "The Plateau", and the occlusion effect. Literature shows differences regarding when and how to use masking; however, common criteria can be established with reference to the levels of interaural attenuation, when to use masking, occlusion effect values and methodology. The plateau method proposed by Hood is still the most recommended. Yacullo's optimization is currently the one with the most references and recommendations in specialized literature.

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A mnemonic to assist patients with topical steroid application

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Corrigendum to Objective volumetric grading of postacne scarring J Am Acad Dermatol Volume 75 (2016) 229–231

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Sonolocation during submandibular sialolithotomy

Objectives/Hypothesis

Ultrasound is a proven tool for diagnostic and therapeutic purposes for treatment of salivary gland pathology. It is also useful for localization of calculi during submandibular gland transoral sialolithotomy when calculi cannot easily be palpated. Our objective was to determine the efficacy of sialolith localization using ultrasound during submandibular gland sialolithotomy.

Study Design

Retrospective case series.

Methods

A study performed utilizing data compiled from 2009 through 2016 in a tertiary academic center. Treatment was completed in 164 patients with sialadenitis and sialolithiasis by submandibular gland transoral sialolithotomy in either the office (81%) or the operating room (19%). Ultrasound was used for localization of sialoliths during submandibular gland sialolithotomy. Main treatment outcomes studied were success of the procedure, complications, and follow‐up.

Results

Successful sialolithotomy was performed in (147 patients) 90% of cases. Complications were minimal and included stricture formation, which occurred in 3% (five patients) of cases, followed by ranula formation in 1.8% (three patients) of cases. There were no incidences of lingual nerve injury.

Conclusions

Ultrasound can be used effectively for precise sialolith localization intraoperatively.

Level of Evidence

4

Laryngoscope, 2019

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Prognostic indicators of survival in sinonasal extranodal natural killer/T‐cell lymphoma

Objectives

Extranodal natural killer/T‐cell lymphoma (ENKTL) is a highly aggressive tumor of the sinonasal tract associated with poor overall survival (OS). This study expands upon epidemiologic, prognostic, and treatment factors for OS and disease‐specific survival (DSS), incorporating newly accessible chemotherapy data.

Methods

Retrospective population‐based cohort study performed on cases of sinonasal ENKTL identified through the Surveillance, Epidemiology, and End Results database. Univariate Kaplan‐Meier analysis and subsequent multivariate Cox‐regression analysis were performed to evaluate prognostic and treatment variables for OS and DSS.

Results

Four hundred and sixty cases of sinonasal ENKTL were identified. Five‐year OS and DSS were 46% and 56%, respectively. On multivariate analysis, higher Ann Arbor stage was associated with worse OS (P < 0.001) and DSS (P < 0.001), whereas administration of radiotherapy was associated with improved OS (P < 0.001) and DSS (P = 0.001). Additionally, a higher age at diagnosis was associated with reduced OS (P = 0.024). Chemotherapy was associated with improved OS (P < .01) and DSS (P = .04) for Ann Arbor stage I disease. Surgery was not associated with improved survival.

Conclusion

This represents the first study to investigate the use of chemotherapy for the treatment of sinonasal ENKTL using population‐based analysis. Radiation therapy and chemotherapy significantly improve survival in all Ann Arbor stage patients and early‐stage patients, respectively. Early‐stage disease is significantly associated with improved survival. With no established treatment regimen for sinonasal ENKTL, these findings suggest combination chemoradiation is an effective therapy for prolonged survival, especially in early stages of disease.

Level of Evidence

3.

Laryngoscope, 2019

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Rapid Onset of Effect of Benralizumab on Morning Peak Expiratory Flow in Severe, Uncontrolled Asthma

Benralizumab (Fasenra™) is an interleukin (IL)-5 receptor alpha–directed cytolytic monoclonal antibody that induces direct, rapid, and nearly complete depletion of eosinophils in the circulation.1 Benralizumab is approved for use in Canada, Europe, Japan, and the United States.2–5 In the United States, it is indicated for the add-on maintenance treatment of patients with severe asthma aged 12 years and older with an eosinophilic phenotype.2 In the SIROCCO (NCT01928771) and CALIMA (NCT01914757) Phase III clinical trials, benralizumab treatment significantly reduced asthma exacerbations, increased lung function, and improved asthma symptoms in patients with severe, uncontrolled asthma and baseline blood eosinophil counts ≥300 cells/μL.

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Speech intelligibility in patients with oral cancer: An objective baseline evaluation of pretreatment function and impairment

Abstract

Background

This study seeks to identify those factors that influence the pre‐therapeutic speech intelligibility in patients with oral squamous cell carcinoma (OSCC).

Method

A group of 172 patients (125 males, 47 females, mean age = 61 ± 11 a) with different OSCC stages ranging from T1 to T4 and N0 to N2 was examined for their speech intelligibility using a computerized measuring tool, and compared to a healthy reference group (30 males, 10 females, mean age = 59 ± 12 a).

Results

It was found that the pre‐therapeutic speech intelligibility in patients with OSCC is decreased when compared to a healthy collective. Two demographic factors that influence speech intelligibility could be identified: sex and age. It was determined that the only disease‐related factor that influences speech intelligibility before therapy is the location of the tumor.

Conclusion

The results of this study reveal that a preoperative speech intelligibility impairment in patients suffering from OSCC occurs independent of tumor stage, size of the tumor and infiltration status.

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Adding clarity to the historical evolution of the selective neck dissection

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Monitoring of respiratory resistance in the diagnosis of mild‐intermittent asthma

Abstract

The evidence of significant variability in lung function is required to confirm the clinical diagnosis of asthma [1]. This is commonly obtained in laboratory settings by bronchoreversibility or bronchoprovocation testing. Because the hallmark of asthma is the variability of symptoms, a more clinically relevant method to confirm the diagnosis should be by revealing an increase of spontaneous variability in lung function [1].

This article is protected by copyright. All rights reserved.

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The complex role of mast cells in fungal infections

Abstract

In addition to their critical role in allergic disorders, mast cells (MCs) are well recognized for their protective effector functions during bacteria and parasite infections. This review describes recent advancements of our understanding of the complex role of MCs in fungal infections. Specifically, we outline key features of the contribution of MCs to infections with six fungal pathogens, namelySporothrix, Paracoccidioides, Aspergillus, Malassezia,Candida andDermatophytes. Evidence from studies of these pathogens suggests that MCs can function as positive regulators that detect and contain fungi at the site of infection. However, it appears that the inflammation induced by MCs following fungal infections may not always and only be beneficial to the host. MC responses during fungal infections may primarily benefit the pathogen by facilitating its spreading and contributing to a greater severity of fungal infections.This review also highlights key drivers of MCs activation and effector mechanisms that have been identified for the multidimensional function of MCs in fungal diseases and in allergic diseases combined with fungal infection.

This article is protected by copyright. All rights reserved.

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Differential expression of inflammatory cytokines and chemokines in lipopolysaccharide‐stimulated melanocytes from lightly and darkly pigmented skin

Abstract

Increasing evidence suggests that human epidermal melanocytes play an important role in the skin immune system, however, a role of their pigmentation in immune and inflammatory responses is poorly examined. In the study expression of Toll‐like receptor 4 (TLR4) and inflammatory cytokines and chemokines by cultured normal melanocytes derived from lightly and darkly pigmented skin was investigated after cell stimulation with lipopolysaccharide (LPS). The basal TLR4 mRNA level in heavily pigmented cells was higher as compared to their lightly pigmented counterparts. Melanocyte exposure to LPS upregulated the expression of TLR4 mRNA and enhanced the DNA‐binding activity of NF‐κB p50 and p65. We found substantial differences in the LPS‐stimulated expression of numerous genes encoding inflammatory cytokines and chemokines between the cells with various melanin contents. In lightly pigmented melanocytes the most significantly upregulated genes were nicotinamide phosphoribosyltransferase (NAMPT/visfatin), the chemokines CCL2 and CCL20, and IL6, while the genes for CXCL12, IL‐16 and the chemokine receptor CCR4 were the most significantly upregulated in heavily pigmented cells. Moreover, the lightly pigmented melanocytes secreted much more NAMPT, CCL2 and IL‐6. The results of our study suggest modulatory effect of melanogenesis on the immune properties of normal epidermal melanocytes.

This article is protected by copyright. All rights reserved.

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A multiscale hybrid mathematical model of epidermal‐dermal interactions during skin wound healing

Abstract

Following injury, skin activates a complex wound healing program. While cellular and signaling mechanisms of wound repair have been extensively studied, the principles of epidermal‐dermal interactions and their effects on wound healing outcomes are only partially understood. To gain new insight into the effects of epidermal‐dermal interactions, we developed a multiscale, hybrid mathematical model of skin wound healing. The model takes into consideration interactions between epidermis and dermis across the basement membrane via diffusible signals, defined as activator and inhibitor. Simulations revealed that epidermal‐dermal interactions are critical for proper extracellular matrix deposition in the dermis, suggesting these signals may influence how wound scars form. Our model makes several theoretical predictions. First, basal levels of epidermal activator and inhibitor help to maintain dermis in a steady‐state, whereas their absence results in a raised, scar‐like dermal phenotype. Second, wound‐triggered increase in activator and inhibitor production by basal epidermal cells, coupled with fast re‐epithelialization kinetics reduce dermal scar size. Third, high density fibrin clot leads to a raised, hypertrophic scar phenotype, whereas low density fibrin clot leads to a hypotrophic phenotype. Fourth, shallow wounds, compared to deep wounds, result in overall reduced scarring. Taken together, our model predicts the important role of signaling across dermal‐epidermal interface and the effect of fibrin clot density and wound geometry on scar formation. This hybrid modeling approach may be also applicable to other complex tissue systems, enabling the simulation of dynamic processes, otherwise computationally prohibitive with fully discrete models due to a large number of variables.

This article is protected by copyright. All rights reserved.

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Primary prevention of keratinocyte carcinoma among outdoor workers, the general population and medical professionals: a systematic review updated for 2019

Abstract

Worldwide 2 to 3 million cases of keratinocyte carcinoma (KC) are diagnosed annually. Sun‐related knowledge is essential for adequate protection against solar ultraviolet radiation (UVR), the main risk factor for KC. The goal was (i) to provide an updated overview of primary prevention against KC including skin cancer‐related knowledge, attitudes and sun protection behaviour (SPB) of outdoor workers, the general population and medical professionals as well as (ii) to evaluate the effectiveness and acceptability of sun‐protection programmes. We conducted a systematic review of articles indexed for MEDLINE on PubMed using selected MeSH terms and keywords related to the studied topic as well as an extensive hand search of publications between January 1^st, 2012 and December 31^st, 2018. We identified 51 relevant cross‐sectional studies and 22 interventional studies. Sun‐related knowledge and attitude showed substantial differences with some alarming results, including people who had not even heard about skin cancer before. Reported SPB varied enormously between the included studies, with none of the studies providing an overall sufficient SPB in their examined sun protection measures. However, sun‐protection programmes using new technologies seem to have great potential to increase sun‐related knowledge and SPB. In countries worldwide, particularly in those where KC is not yet a public health issue, UVR protection should be promoted by health care institutions and authorities, politicians, cancer foundations and dermatologists to increase awareness as well as SPB and to decrease the worldwide burden of KC.

This article is protected by copyright. All rights reserved.

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Skin cancer prevention: a review of current topical options complementary to sunscreens

Abstract

The incidence of non‐melanoma skin cancer (NMSC) is dramatically increasing worldwide, despite the increased use of improved sunscreens. In 2014, the Surgeon General estimated that 2.2 to 5.0 million people were treated annually for NMSC. As the number of newly diagnosed skin cancers continues to rise, there is a need for additional preventative measures beyond sunscreens. Several newer topical products that focus on boosting DNA repair, modulating DNA transcription, decreasing inflammation, and selectively targeting precancerous cells may play an important role in future skin cancer prevention.

This article is protected by copyright. All rights reserved.

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Zinc and atopic dermatitis: a systematic review and meta‐analysis

Abstract

Zinc plays a central role in skin integrity via barrier and immune mechanisms and may also be relevant in the pathogenesis of atopic dermatitis (AD). However, little is known about the relationship between zinc and AD. We performed a systematic review to determine 1) the association between zinc levels or zinc deficiency and AD and 2) the efficacy of oral zinc supplementation in the treatment of AD. We searched PubMed, Scopus, Web of Science and article references for observational studies on zinc levels or zinc deficiency in participants with AD versus controls and for RCTs on zinc supplementation in AD. For observational studies, we calculated pooled standardised mean differences (SMDs) or odds ratios (ORs) along with 95% confidence intervals (CIs) using a random effects model. We included 14 observational studies and 2 RCTs. The pooled SMD demonstrated significantly lower serum (SMD 0.66, 95% CI 0.21‐1.10, p=0.004), hair (SMD 0.95, 95% CI 0.38‐1.52, p=0.001) and erythrocyte (SMD 0.95, 95% CI 0.38‐1.52, p=0.001) zinc levels in participants with AD compared to controls. Pooled unadjusted data from 3 studies showed a non‐significant increased odds of AD in those with zinc deficiency compared with those without zinc deficiency (OR=1.50, 95% CI 0.71‐3.16, p=0.28). One RCT of oral zinc supplementation among AD patients with zinc deficiency showed improvement in extent and severity of AD, while another RCT among all AD patients showed no significant improvement. All the studies were of low or moderate quality. We conclude that low serum, hair, and erythrocyte zinc levels are associated with AD. However, the poor quality of included studies make interpretation of these results problematic. High quality observational studies are needed to confirm the association between low zinc levels and AD, and RCTs are required to evaluate the merit of zinc supplementation for the treatment or prevention of AD.

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Virulent Staphylococcus lugdunensis with limited genetic diversity in hidradenitis suppurativa lesions

Abstract

Hidradenitis suppurativa (HS) is an inflammatory skin disease characterized by recurring painful, deep‐seated inflammatory nodules, abscesses, sinus tracts, and scarring in the intertriginous areas. Bacteria may be involved in the pathogenesis of HS via follicular dysbiosis in the initial stages, and via biofilm in chronic sinus tracts. Staphylococcus lugdunensis, a coagulase‐negative staphylococcus (CNS), has been cultured from hidradenitis suppurativa nodules and abscesses. This points towards a role of S. lugdunensis in the aggravation and secondary colonization of HS lesions.

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Ingenol mebutate‐mediated reduction of p53‐positive keratinocytes in skin cancerization field directly correlates with clinical response in patients with multiple actinic keratoses

Abstract

Background

UV radiation represents the main risk factor for Non Melanoma Skin Cancers (NMSC). Chronic UV exposure induces "p53 patches", i.e. clonal outgrowths of keratinocytes with high nuclear expression of mutated p53, which might progress to actinic keratosis (AK) and ultimately squamous cell carcinomas (SCC).

Aims

Analysis of Ingenol mebutate gel (150 and 500 mcg/g) effects in the reduction of "p53 patches" inside skin cancerization field (CF) in patients with multiple AKs of face/scalp or trunk/extremities, in order to investigate if the expected reduction of p53⁺ keratinocytes might have a direct role in the long‐term AK reduction in treated areas.

Results

We enrolled n=10 patients, treated with Ingenol mebutate and evaluated at 2 and 6 months after treatment. We observed clinical responses in the majority of patients (n=7), with AK reduction or complete clearance (n=6 and n=1, respectively). Notably, two patients did not respond to the treatment and in one patient, after initial partial response, new lesion were recorded. In untreated skin CF samples (n=3), we observed numerous p53⁺ keratinocytes, similar to those observed in invasive SCC samples (53.56±8.79 and 74.34±22.05, respectively; p=0.2). After treatment, we observed a variable p53⁺ keratinocytes reduction in CF samples at 2 months (24.67±31.19; p=0.19). Importantly, the amount of p53⁺ keratinocytes strongly and directly correlated with AK number (R² =0.81).

Conclusion

Untreated skin CF expresses high level of p53⁺ keratinocytes as invasive SCC. Ingenol mebutate is able to reduce p53⁺ keratinocytes with variable efficacy, this reduction degree directly correlating with clinical efficacy.

This article is protected by copyright. All rights reserved.

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Epidemiology and prognostic factors for mycosis fungoides and Sézary syndrome in a multi‐ethnic Asian cohort: A 12‐year review

Summary

Background

Limited information exists regarding survival of Asian patients with mycosis fungoides (MF) and Sézary syndrome (SS).

Objective

To evaluate the epidemiology, outcome and prognostic factors of these patients.

Methods

A retrospective review of MF/SS cases diagnosed from 2000 to 2011 at a tertiary referral dermatology centre in Singapore was performed.

Results

Of 246 patients, 63% were male and the median age at diagnosis was 49 years. 73.2% were Chinese, 12.6% Indian, 6.9% Malay and 7.3% Caucasian. 239 patients (97.2%) had MF and 7 had SS. Median follow‐up duration was 6.3 years and median duration of symptoms at diagnosis was 13 months. For patients with MF, the majority had early disease (92.8% stage IA‐IIA). 3.8% were stage IIB, 1.7% stage III and 1.7% stage IV. Complete response to treatment occurred in 78.2%, partial response in 9.6%, persistent but non‐progressive disease in 10.0% and disease progression in 4.1% of patients. Large cell transformation occurred in 4.1% of patients. Mean overall survival during this study was 12.7 years, with death occurring in 2.5% of patients (all ≥ stage IIB at diagnosis). For patients with SS, 71.4% presented with stage IVA disease, 28.6% stage IVB. Complete response to treatment occurred in 14.2%, persistent but non‐progressive disease in 28.6% and disease progression in 57.2% of patients. Mean overall survival was 3.3 years within this study, with death occurring in 42.9% of SS patients. Prognostic factors associated with favourable recurrence‐free survival were male gender (p = 0.008), early disease stage (T1) at diagnosis (p < 0.001) and absence of maintenance treatment after remission (p = 0.01).

Conclusion

Compared to Caucasian and East Asian cohorts, MF in Southeast Asians was diagnosed at a younger age and associated with lower mortality, largely due to greater prevalence of hypopigmented MF.

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In this issue

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Management of laryngeal papillomatosis using coblation: another option of surgical intervention

Abstract

Purpose

Recurrent respiratory papillomatosis is a disease caused by the human papilloma virus (HPV). HPV is frequently localised in the larynx. The disease tends to recur and frequent intervention is usually required. Management modules include surgical intervention using microdebriders or laser ablation as well as adjuvant treatments which aim mainly at maintaining an adequate airway and secondly to manage dysphonia caused by the growth on the vocal folds. In this pilot study, another surgical modality is trialled using plasma-mediated radio-frequency ablation (coblation).

Methods

Retrospective study examining management of 15 adult patients diagnosed with recurrent laryngeal papillomatosis and surgically treated using coblation. One patient required multiple procedures. Pre-operative assessment in voice clinic evaluating voice quality and its impact on patients' life-quality using voice parameters and self-assessment questionnaires. Follow-up post-operatively using the same parameters from 4 to 6 weeks after surgery until up to 2 years later to check recurrence rate. No other adjuvant treatment was used and all patients received post-operative voice therapy.

Results

78.6% of patients did not show evidence of recurrence during the study period. Improvement in voice handicap following first intervention is reported and recurrence rate in the rest of the sample reported.

Conclusions

The results of this small sample seem to support the previous small studies' findings that coblation is a good excisional technique to use for removal of laryngeal papillomatosis. Recurrence rates seem to be slightly lower than rates reported in the literature for the other surgical modalities.

Level of evidence

IV.

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Utilization of high-fidelity simulation for medical student and resident education of allergic-immunologic emergencies

Publication date: Available online 23 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Stephanie L. Mawhirt, Luz Fonacier, Marcella Aquino

https://ift.tt/2NmvbDW

Cockroach, Dust Mite, and Shrimp Sensitization Correlations in The National Health and Nutrition Examination Survey

Publication date: Available online 23 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Emily C. McGowan, Roger Peng, Päivi M. Salo, Darryl C. Zeldin, Corinne A. Keet

https://ift.tt/2NpqOrY

Retrospective Review of Insurance Coverage for Patch Testing

Publication date: Available online 23 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Azam A. Qureshi, Olabola Awosika, Kamaria Nelson, Spencer Brodsky, Haijun Wang, Alison Ehrlich

https://ift.tt/2GFRjJ2

Perspective Pro Debate: To introduce solids early or not to introduce, this is the question.

Publication date: Available online 22 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Helen R. Fisher, Gideon Lack, George Du Toit

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Anatomical and frequencies-specific hearing results of retrograde mastoidectomy

Publication date: Available online 22 February 2019

Source: American Journal of Otolaryngology

Author(s): Emine Demir, Gorkem Atsal, Oben Yildirim, Filiz Gulustan, Abdullah Dalgic, Tolgahan Catli, Levent Olgun

https://ift.tt/2EqSqdj

Anesthesia and ventilation options for flex robotic assisted laryngopharyngeal surgery

Publication date: Available online 22 February 2019

Source: American Journal of Otolaryngology

Author(s): Yosef Krespi, Victor Kizhner, Robert Koorn, Anthony Giordano

Abstract

Background

Transoral treatment of benign and malignant lesions of laryngopharynx has limitations in exposure and access, partially due to the endotracheal tube (ETT). With a proper airway control to tailor ventilation and maximize exposure, transoral Flex robotic surgery (FLEX), using its 3D camera and instruments, can expand its ability. Choosing the right ETT, including a novel concept of using jet ventilation (JV) in FLEX, and placement technique can allow augmentation of the advantages that robotic surgery offers.

Methods

Chart review of FLEX assisted procedures was performed. Attention was given to demographics, all events of airway manipulation and ventilation type, procedures performed and outcomes including adverse effects.

Results

Fifty-two patients underwent eighty procedures. The airway was manipulated sixty-four times to include 8 JV. All possible FLEX instruments including CO2 laser were used. Three novel possible indications for trans-oral robotic surgery including the feasibility of JV in FLEX procedures were shown.

Conclusions

Lesions of the tongue base, hypopharynx, larynx and trachea have the possibility to be managed with adequate exposure with minimal obstruction from ETT. Robotic HD camera permits both the surgeon and anesthesiologist to observe surgery and safely monitor the airway. An algorithm was developed for selecting ideal ventilation method for different procedures. The FLEX and the utilization of JV allows flexibility of two instruments without obstruction.

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Normalization of breathing with adenotonsillectomy in Japanese pediatric OSA

Publication date: Available online 22 February 2019

Source: Auris Nasus Larynx

Author(s): Sachie Arima, Shigefumi Koike, Maki Fujinaga, Takenao Mihara, Shintaro Sato, Motohiko Suzuki, Shingo Murakami, Meiho Nakayama

Abstract

Objective

Since reports on surgical results for pediatric obstructive sleep apnea (OSA) in Japan are insufficient for debate, this study aimed to evaluate the feature of Japanese OSA children and surgical result and document whether is obesity and affecting factor similar to non-Asian countries.

Methods

This is a retrospective study. A total of 242 children with OSA at the Department of Otolaryngology and the Good Sleep Center, Nagoya City University Hospital and the Toyohashi Mates Sleep Disorders Center were included in the study. All children underwent pre- and postsurgical polysomnography. OSA was defined as an apnea hypopnea index (AHI) 5 or greater. Pre- and postsurgical respiratory parameters were compared using paired T test.

Results

Normalization of breathing after surgery for OSA children was 40% with AHI < 2 and 85% with AHI < 5. Japanese OSA children are not as obese as OSA children in many non-Asian countries. However, the normalization of breathing as a result of surgery in Japanese OSA children does not differ much from non-Asian countries.

Conclusion

Japanese pediatric OSA that is not normalized by surgery may be affected by factors other than obesity.

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Sublingual administration of liposomes enclosing alpha-galactosylceramide as an effective adjuvant of allergen immunotherapy in a murine model of allergic rhinitis

Publication date: Available online 22 February 2019

Source: Allergology International

Author(s): Satoshi Suzuki, Daiju Sakurai, Toshioki Sakurai, Syuji Yonekura, Tomohisa Iinuma, Yusuke Okuma, Fumie Ihara, Tomoyuki Arai, Toyoyuki Hanazawa, Emi Fukuda-Kawaguchi, Yasuyuki Ishii, Yoshitaka Okamoto

Abstract

Background

Sublingual immunotherapy (SLIT) is an established efficacious approach for the treatment of allergic rhinitis (AR). However, SLIT requires a long administration period to establish stable and adequate responses. This study investigated the efficacy of the sublingual administration of an allergen with liposomes enclosing α-GalCer (α-GC-liposome) as a potential adjuvant in mice with AR.

Methods

Mice with AR induced by OVA received the sublingual administration of OVA, α-GC-liposomes, or OVA plus α-GC-liposomes for 7 days. After nasal re-challenge with OVA, nasal symptoms were evaluated. The serum levels of OVA-specific Ig, the cytokine production of CD4⁺ T cells in the cultures of cervical lymph node (CLN) cells, and the gene expression of CLNs were analyzed.

Results

Although IL-4, IL-5 and IL-13 production from CD4⁺ T cells in CLN cells was significantly inhibited by the sublingual administration of OVA alone in mice with AR induced by OVA, their nasal symptoms were not significantly diminished. However, the combined sublingual administration of α-GC-liposomes and OVA completely suppressed nasal symptoms, downregulated Th2 and Th17 type cytokine production in CD4⁺ T cells as well as Th2 and Th17 gene expressions, and upregulated Th1 type cytokine production as well as Th1 gene expressions in CLN cells. Additionally, the serum levels of specific IgG2a were promoted, and specific IgE and IgG1 were inhibited.

Conclusions

Our findings suggest that the sublingual administration of an allergen with α-GC-liposomes as an adjuvant might increase the therapeutic efficacy and effectiveness of this treatment method.

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Differentiation between control subjects and patients with chronic spontaneous urticaria based on the ability of anti-IgE autoantibodies (AAbs) to induce FcεRI crosslinking, as compared to anti-FcεRIα AAbs

Publication date: Available online 22 February 2019

Source: Allergology International

Author(s): Satoshi Izaki, Shota Toyoshima, Takahiro Endo, Kazuko Kanegae, Satoshi Nunomura, Jun-ichi Kashiwakura, Tomomi Sasaki-Sakamoto, Ryosuke Nakamura, Haruyo Akiyama, Chisei Ra, Koremasa Hayama, Tadashi Terui, Yoshimichi Okayama

Abstract

Background

The reported prevalences of IgG autoantibodies (AAbs) to FcεRIα and IgE in sera from patients with chronic spontaneous urticaria (CSU) have varied, and these AAbs are also often observed in healthy control subjects. Regarding the histamine release activity of purified IgG from patients with CSU, the number of examined patients has been small. Thus, we sought to determine the prevalence and FcεRI crosslinking ability of these AAbs in a large number of patients with CSU and non-atopic control (NC) subjects.

Methods

We compared the concentrations of anti-IgE and anti-FcεRIα AAbs and the abilities of these AAbs to cause FcεRI aggregation in patients with CSU (n = 134) and NC subjects (n = 55) using ELISA and an in vitro elicitation test, respectively.

Results

The concentration of anti-IgE AAbs was significantly different between the NC subjects and the CSU patients (P < 0.0001, cutoff value: 0.558 μg/mL), whereas the concentration of anti-FcεRIα AAbs was not. A significant difference in the duration of illness was noted between patients with lower and those with higher concentrations of anti-IgE AAbs relative to the cutoff value. The abilities of anti-IgE AAbs, but not anti-FcεRIα AAbs, to induce FcεRI crosslinking were significantly higher in CSU patients than in NC subjects (P = 0.0106).

Conclusions

In the Japanese population of CSU patients studied, the ability of the anti-IgE AAbs to induce FcεRI crosslinking differed significantly between NC subjects and CSU patients, suggesting the involvement of anti-IgE AAbs in the pathogenesis of CSU in the Japanese population.

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Total IgE and atopic status in patients with severe chronic spontaneous urticaria unresponsive to omalizumab treatment

https://ift.tt/2XjJNsw

Tonsillar Hyperplasia and Recurrent Acute Tonsillitis in children: immunohistochemical evaluation of the lymphatic tissue

Publication date: Available online 23 February 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): João Henrique do Amaral e Silva, Élia Cláudia de Souza Almeida, Júlio Cláudio Sousa, Luciana Guedes Vilela Reis, Jacqueline Batista Sousa, Renata Margarida Etchebehere

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Pituitary macroadenoma presenting as severe hyponatremia: a case report

Hyponatremia is defined as a serum sodium level of less than 135 mEq/L in a patient. Although hyponatremia is not an uncommon laboratory finding, especially in the elderly, hunting for the etiology is a challe...

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Cortical auditory evoked potential in babies and children listeners

Publication date: Available online 22 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Ana Carla Leite Romero, Ana Claudia Figueiredo Frizzo, Eduardo Federighi Baisi Chagas, Myriam de Lima Isaac

Abstract

Introduction

Cortical auditory evoked potentials have been increasingly used in research and audiological routines. However, there is a lack of studies with a large number of children who are stratified by age group. These would help clarify the variations in latency and amplitude of cortical auditory evoked potentials, and thus help establish reference values in children of different ages.

Objective

To identify the variation in latency and amplitude of the cortical auditory evoked potentials and to establish reference values for the pediatric population.

Methods

This was a cross-sectional study. Subjects were born at term and presented with no auditory complaints. A total of 105 children, of up to 6 years and eleven months old, who were divided into 7 age groups, named 1, 2, 3, 4, 5, 6 and 7, participated in the study. The tests were carried out using Biologic Navigator Pro. Initially, brainstem auditory evoked potential testing was performed in order to investigate the electrophysiological threshold of the subjects. Then, cortical auditory evoked potentials were elicited through oddball paradigm with tone burst differing in frequency, 750 Hz (frequent) and 1000 Hz (rare), and stimuli differing in speech: /ba/ (frequent) and /da/ (rare). In this study, descriptive and comparative analyzes of tonal and speech stimuli were performed for the age groups.

Results

Significant differences were observed when comparing cortical auditory evoked potentials with speech stimulus in the right ear for P2 amplitude, for P1 latency the left ear, for P2 amplitude of the left ear; and for P1 amplitude of the left ear when performed with tonal stimuli.

Conclusion

The obtained results can be considered as reference values of latency and amplitude of cortical auditory potentials in infants and children, and be used for monitoring their cortical auditory development.

Resumo

Introdução

Os potenciais evocados auditivos corticais têm sido cada vez mais utilizados em pesquisas e rotinas audiológicas. É importante que mais pesquisas sejam realizadas com maior número de crianças por faixa etária, a fim de contribuir para o conhecimento e descrever a variação das medidas de latência e amplitude, permitindo estabelecer valores de referência desse potencial para crianças de diferentes grupos etários.

Objetivo

Identificar a variação das medidas de latência e amplitude e estabelecer os valores de referência desse potencial para a população pediátrica.

Método

Este foi um estudo do tipo transversal. Os indivíduos nasceram a termo, com ausência de queixas auditivas. Participaram do estudo 105 crianças de até 6 anos e 11 meses de idade, divididas em 7 grupos de idade, denominados 1, 2, 3, 4, 5, 6 e 7. Os testes foram realizados utilizando-se o Biologic Navigator Pro. Inicialmente, foi realizado o potencial evocado auditivo de tronco encefálico para investigar o limiar eletrofisiológico dos indivíduos. Em seguida, o potencial evocado auditivo cortical foi realizado através do paradigma de oddball com tone burst diferindo em frequência, 750 Hz (frequente) e 1000 Hz (raro) e estímulo diferindo na fala: / ba/ (frequente) e /da/ (raro). Neste estudo, foram realizadas análises descritivas e comparativas dos estímulos tonais e de fala para os grupos etários.

Resultados

Diferenças significantes foram observadas na comparação do potencial evocado auditivo cortical com estímulo de fala da orelha direita para amplitude de P2, para latência de P1 da orelha esquerda, para amplitude de P2 da orelha esquerda; e para amplitude de P1 da orelha esquerda quando realizada com estímulo tonal.

Conclusõo

Os resultados obtidos podem ser utilizados como medidas de referência de latência e amplitude dos potenciais auditivos corticais em lactentes e crianças, bem como para monitorar o desenvolvimento auditivo cortical.

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Changes in substance P levels of inferior turbinate in patients with mucosal contact headache

Publication date: Available online 22 February 2019

Source: Brazilian Journal of Otorhinolaryngology

Author(s): Hülya Eyigör, Mete Eyigor, Bekir Erol, Ömer Tarık Selcuk, Levent Renda, Mustafa Deniz Yılmaz, Üstün Osma, Cansu Demirkiran, Meral Gültekin, Nuray Erin

Abstract

Introduction

Mucosal contact headache is a referred pain that arises from contact between the nasal septum and the lateral nasal wall. Evidence supports the role of substance P in a contact headache such that release of substance P from sensory nerve endings causes inflammation and allergy.

Objective

This study aimed to determine possible differences in substance P levels in inferior turbinate hypertrophy creating a contact headache.

Methods

28 patients who had contact headaches (Study Group) and 16 volunteers with no complaints were included in the study. Substance P levels in the inferior turbinate tissue samples were quantified using a commercially available substance P EIA kit.

Results

In the study group average substance P levels were 2.65 ± 0.27 pg/mg tissue (range: 0.61–5.44) and in the control group it was 1.77 ± 0.27 pg/mg tissue (range: 0.11–4.35). The difference was statistically significant between the two groups (p = 0.0215). Average preoperative headache group visual analog scale scores was 5.93 ± 0.38 (2–9) and the turbinate volume was 6.56 ± 0.35 cm³ (3.50–10.30). The control group turbinate volume was 4.71 ± 0.39 cm³ (2.50–7.70). We found a correlation between the visual analog scale scores and substance P levels such that substance P levels were higher in visual analog scale scores above 5 (p = 0.001).

Conclusion

This study demonstrates the relationship between intranasal contact headaches and increased mucosal substance P levels. We also found that there is no correlation with substance P levels and volume of the inferior turbinate.

Resumo

Introdução

A cefaleia por ponto de contato da mucosa é uma dor direcionada que surge do contato entre o septo nasal e a parede nasal lateral. Evidências corroboram o papel da substância P na cefaleia de contato, de tal forma que a liberação da mesma a partir de terminações nervosas sensoriais possa causar inflamação e alergia.

Objetivo

O objetivo deste estudo foi determinar possíveis diferenças nos níveis da substância P na hipertrofia de conchas inferiores em relação à cefaleia de contato.

Método

28 pacientes que apresentaram cefaleia por ponto de contato (Grupo Estudo) e 16 voluntários sem queixas foram incluídos no estudo. Os níveis de substância P nas amostras de tecido da concha inferior foram quantificados utilizando-se um kit substância P EIA, comercialmente disponível.

Resultados

No grupo do estudo, os níveis médios de substância P foram 2,65 ± 0,27 pg/mg de tecido (variação: 0,61–5,44) e no grupo controle foram de 1,77 ± 0,27 pg/mg de tecido (variação: 0,11-4,35), e a diferença foi estatisticamente significante entre os dois grupos (p = 0,0215). O escore médio da escala visual analógica do grupo de cefaleia pré-operatória foi de 5,93 ± 0,38 (2–9) e o volume das conchas foi de 6,56 ± 0,35 cm³ (3,50–10,30). O volume da concha do grupo controle foi de 4,71 ± 0,39 cm³ (2,50 ± 7,70). Encontramos uma correlação entre o escore da escala visual analógica e os níveis de substância P, de modo que os níveis de substância P foram maiores nos escores da escala visual analógica acima de 5 (p = 0,001).

Conclusão

Este estudo demonstra a relação entre cefaleias por contato intranasais e níveis aumentados de substância P nas mucosas. Também observamos que não há correlação com os níveis de substância P e o volume da concha inferior.

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Comparison of the Financial Burden of Survivors of Head and Neck Cancer With Other Cancer Survivors.

Related Articles

Comparison of the Financial Burden of Survivors of Head and Neck Cancer With Other Cancer Survivors.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 21;:

Authors: Massa ST, Osazuwa-Peters N, Adjei Boakye E, Walker RJ, Ward GM

Abstract
Importance: Head and neck cancer (HNC) is more common among socioeconomically disenfranchised individuals, making financial burden particularly relevant.
Objective: To assess the financial burdens of HNC compared with other cancers.
Design, Setting, and Participants: In this retrospective review of nationally representative, publicly available survey, data from the Medical Expenditure Panel Survey were extracted from January 1, 1998, to December 31, 2015. A total of 444 867 adults were surveyed, which extrapolates to a population of 221 503 108 based on the weighted survey design. Data analysis was performed from April 18, 2018, to August 20, 2018.
Exposures: Of 16 771 patients with cancer surveyed (weighted count of 10 083 586 patients), 489 reported HNC (weighted count of 261 631).
Main Outcomes and Measures: Patients with HNC were compared with patients with other cancers on demographics, income, employment, and health. Within the HNC group, risk factors for total medical expenses and relative out-of-pocket expenses were assessed with regression modeling. Complex sampling methods were accounted for with weighting using balanced repeated replication.
Results: A total of 16 771 patients (mean [SD] age, 62.3 [18.9] years; 9006 [53.7%] female) with cancer were studied. Compared with patients with other cancers, patients with HNC were more often members of a minority race/ethnicity, male, poor, publicly insured, and less educated, with lower general and mental health status. Median annual medical expenses ($8384 vs $5978; difference, $2406; 95% CI, $795-$4017) and relative out-of-pocket expenses (3.93% vs 3.07%; difference, 0.86%; 95% CI, 0.06%-1.66%) were higher for patients with HNC than for patients with other cancers. Among patients with HNC, median expenses were lower for Asian individuals compared with white individuals ($5359 vs $10 078; difference, $4719; 95% CI, $1481-$7956]), Westerners ($8094) and Midwesterners ($5656) compared with Northwesterners ($10 549), and those with better health status ($16 990 for those with poor health vs $6714 for those with excellent health). Higher relative out-of-pocket expenses were associated with unemployment (5.13% for employed patients vs 2.35% for unemployed patients; difference, 2.78%; 95% CI, 0.6%-4.95%), public insurance (5.35% for those with public insurance vs 2.87% for those with private insurance; difference, 2.48%; 95% CI, -0.6% to 5.55%), poverty (13.07% for poor patients vs 2.06% for high-income patients), and lower health status (10.2% for those with poor health vs 1.58% for those with excellent health).
Conclusions and Relevance: According to this study, HNC adds a substantial, additional burden to an already financially strained population in the form of higher total and relative expenses. The financial strain on individuals, assessed as relative out-of-pocket expenses, appears to be driven more by income than by health factors, and health insurance does not appear to be protective.

PMID: 30789634 [PubMed - as supplied by publisher]

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An Unusual Case of Lacrimal Duct Obstruction in a Teenager.

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An Unusual Case of Lacrimal Duct Obstruction in a Teenager.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 21;:

Authors: Ray A, Frey HM, Carron JD

PMID: 30789663 [PubMed - as supplied by publisher]

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Evaluation of a Preoperative Adverse Event Risk Index for Patients Undergoing Head and Neck Cancer Surgery.

Related Articles

Evaluation of a Preoperative Adverse Event Risk Index for Patients Undergoing Head and Neck Cancer Surgery.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 21;:

Authors: Mascarella MA, Richardson K, Mlynarek A, Forest VI, Hier M, Sadeghi N, Mayo N

Abstract
Importance: Patients 65 years or older are the most frequent users of operative resources and are also the most vulnerable to postoperative adverse events (AEs). Frailty indices are increasingly being used for preoperative risk stratification within head and neck cancer surgery, but most models lack a multifactorial basis and cannot be directly applied to clinical practice. A practical risk index is needed for clinicians to gauge risk factors preoperatively.
Objective: To develop a preoperative risk index of short-term major postoperative AEs for patients undergoing head and neck cancer surgery.
Design: Cohort analysis of patients from multiple medical centers undergoing inpatient ablative or reconstructive head and neck cancer surgery and registered in the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) from 2006 to 2016.
Exposures: Inpatient ablative or reconstructive head and neck cancer surgery.
Main Outcomes and Measures: Sociodemographic, frailty-related, and surgical factors in the derivation cohort were evaluated using simple and multiple logistic regression. Risk factors were subsequently integrated into a preoperative head and neck surgery risk index (HNSRI) and compared with existing models using the validation cohort. A composite variable of major postoperative AEs was used, including death within 30 days of surgery.
Results: A total of 43 968 operations were found using the ACS NSQIP database. Of these, 12 569 cases were excluded as non-head and neck cancer or emergency surgery. Of the included 31 399 operations reviewed, the mean (SD) patient age was 56.9 (15.4) years, and 16 994 of the patients were women (54.1%). A total of 4556 (14.5%) patients had a major postoperative AE, and 209 (0.7%) died. Older age, male sex, smoking, anticoagulation, recent weight loss, functional dependence, free-tissue transfer, tracheotomy, duration of surgery, wound classification, anemia, leukocytosis, and hypoalbuminemia were independently associated with major AEs or death on multiple regression analysis (C statistic, 0.83). The area under the curve of the HNSRI to predict major AEs including death using the validation cohort (n = 15699) was 0.84 (95% CI, 0.83-0.85) with a sensitivity of 80.1% (95% CI, 79.4%-80.8%) and specificity, 72.3% (95% CI, 70.3%-74.2%). The HNSRI outperformed existing risk models for prediction of AEs: delta C index of the HNSRI to the modified frailty index 11, 0.23 (95% CI, 0.22-0.25); the American Society of Anesthesiologists classification, 0.14 (95% CI, 0.13-0.16); and the ACS risk calculator, 0.02 (95% CI, 0.01-0.03).
Conclusions and Relevance: The proposed HNSRI demonstrated a high sensitivity and specificity for major postoperative AEs and death in the studied population. This risk index can be used to counsel patients awaiting head and neck cancer surgery.

PMID: 30789650 [PubMed - as supplied by publisher]

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Vertebral Bodies, Anterior Erosion, and Compression by Tracheostomy Canula.

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Vertebral Bodies, Anterior Erosion, and Compression by Tracheostomy Canula.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 21;:

Authors: Costa G, Thiry T, Essid A, Mbieleu B, Haegy I, Perrier A, Bergounioux J

PMID: 30789646 [PubMed - as supplied by publisher]

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Eosinophilic Esophagitis-A Primer for Otolaryngologists.

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Eosinophilic Esophagitis-A Primer for Otolaryngologists.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 21;:

Authors: Kumar S, Choi S, Gupta SK

Abstract
Importance: Eosinophilic esophagitis (EoE) is a chronic, inflammatory condition of the esophagus. Prevalence of EoE is on the rise and, owing to its associated extragastrointestinal manifestations and comorbidities, otolaryngologists are increasingly encountering this condition in their practice.
Observations: Symptoms of EoE are vague and vary greatly based on patient's age. The gastrointestinal symptoms include dysphagia, food impaction, feeding difficulties, symptoms mimicking gastroesophageal reflux, abdominal pain, vomiting, and failure to thrive. Several otolaryngologic symptoms are associated with EoE including rhinosinusitis, chronic cough, recurrent croup, hoarseness, and other aerodigestive symptoms refractory to gastroesophageal reflux therapy. Eosinophilic esophagitis is also frequently associated with other atopic conditions, such as asthma, eczema, and food allergies. The diagnosis is made on endoscopy with biopsies that reveal eosinophil-predominant esophageal inflammation. There are 3 major treatment approaches to EoE, commonly referred to as the 3 Ds: diet, drugs, and dilation. Untreated inflammation of esophagus from EoE can result in irreversible structural damage to the esophagus, leading to fibrosis, strictures, and impaired esophageal function.
Conclusions and Relevance: Eosinophilic esophagitis is now a fairly prevalent condition with considerable morbidity. Otolaryngologists should be familiar with the various clinical presentations of this condition in different age groups. Early diagnosis and treatment of this condition is a key for avoiding or postponing its complications.

PMID: 30789641 [PubMed - as supplied by publisher]

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JAMA Otolaryngology-Head & Neck Surgery.

Related Articles

JAMA Otolaryngology-Head & Neck Surgery.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 01;145(2):104

Authors:

PMID: 30789638 [PubMed - in process]

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Error in Figure Labels.

Related Articles

Error in Figure Labels.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 01;145(2):196

Authors:

PMID: 30789636 [PubMed - in process]

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Labels Reversed in Figure 1.

Related Articles

Labels Reversed in Figure 1.

JAMA Otolaryngol Head Neck Surg. 2019 Feb 01;145(2):196

Authors:

PMID: 30789635 [PubMed - in process]

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Head and Neck Cancer Compared With Other Cancers-Does the Great Equalizer Equalize Equally?

Related Articles

Head and Neck Cancer Compared With Other Cancers-Does the Great Equalizer Equalize Equally?

JAMA Otolaryngol Head Neck Surg. 2019 Feb 21;:

Authors: Deschler DG

PMID: 30789631 [PubMed - as supplied by publisher]

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Add‐on probiotics in patients with persistent allergic rhinitis: A randomized crossover clinical trial

Objectives

Current medications for allergic rhinitis (AR) may have undesirable side effects that could affect quality of life (QoL). Probiotics could be an alternative in these patients. The aim of this study was to assess the impact of add‐on probiotics on symptoms and QoL of patients.

Methods

In this randomized crossover clinical trial, patients with persistent AR were included. Each subject received budesonide with probiotic supplements (BP) or budesonide with placebo for 8 weeks (B), then vice versa for a further 8 weeks. There was an 8‐week washout. The primary outcome was the change of the Short Form 36‐Item Health Survey (SF‐36) score. The secondary outcomes were assessed by the Sinonasal Outcome Test‐22 (SNOT‐22) and the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaires.

Results

A total of 152 subjects (30.1 ± 7.6 years) completed the study. The SF‐36 score in both groups showed improvement compared with baseline values. Treatment BP was more effective than that of B. The Cohen's d and the number needed to treat for Physical Component Scales of SF‐36 were 0.40 and 10.77, respectively. These values for Mental Component Scales were 0.33 and 12.61, respectively. Also, treatment BP showed more reduction in the score of SNOT‐22 and CARAT.

Conclusion

This study showed that the addition of probiotics to budesonide significantly improved QoL in persistent AR patients. However, the clinical situation of these patients may be not very representative of AR patients in general population. Further studies are recommended.

Level of Evidence

1b. Laryngoscope, 2019

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3D‐printed, externally‐implanted, bioresorbable airway splints for severe tracheobronchomalacia

Objectives/Hypothesis

To report the clinical safety and efficacy of three‐dimensional (3D)–printed, patient‐specific, bioresorbable airway splints in a cohort of critically ill children with severe tracheobronchomalacia.

Study Design

Case series.

Methods

From 2012 to 2018, 15 subjects received 29 splints on their trachea, right and/or left mainstem bronchi. The median age at implantation was 8 months (range, 3–25 months). Nine children were female. Five subjects had a history of extracorporeal membrane oxygenation (ECMO), and 11 required continuous sedation, six of whom required paralytics to maintain adequate ventilation. Thirteen were chronically hospitalized, unable to be discharged, and seven were hospitalized their entire lives. At the time of splint implantation, one subject required ECMO, one required positive airway pressure, and 13 subjects were tracheostomy and ventilator dependent, requiring a median positive end‐expiratory pressure (PEEP) of 14 cm H₂O (range, 6–20 cm H₂0). Outcomes collected included level of respiratory support, disposition, and splint‐related complications.

Results

At the time of discharge from our institution, at a median of 28 days postimplantation (range, 10–56 days), the subject on ECMO was weaned from extracorporeal support, and the subjects who were ventilated via tracheostomy had a median change in PEEP (discharge–baseline) of −2.5 cm H₂O (range, −15 to 2 cm H₂O, P = .022). At median follow‐up of 8.5 months (range, 0.3–77 months), all but one of the 12 surviving subjects lives at home. Of the 11 survivors who were tracheostomy dependent preoperatively, one is decannulated, one uses a speaking valve, six use a ventilator exclusively at night, and three remain ventilator dependent.

Conclusions

This case series demonstrates the initial clinical efficacy of the 3D‐printed bioresorbable airway splint device in a cohort of critically ill children with severe tracheobronchomalacia.

Level of Evidence

4 Laryngoscope, 2019

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Oxytocin Alleviates Cellular Senescence through Oxytocin Receptor‐Mediated ERK/Nrf2 Signalling

Summary

Background

Oxytocin (OT) is a neuropeptide hormone that has many beneficial biological effects, including protection against age‐related disorders. However, less is known about its role in intrinsic skin ageing, which is accelerated by an increase in senescent cell fraction in skin tissue.

Objectives

Here, we investigated the novel function and the underlying mechanism of OT in preventing cellular senescence in normal human dermal fibroblasts (NHDFs) isolated from the skin of female donors of different ages.

Methods

NHDFs from young and old donors were exposed to conditioned medium (CM) from senescent or control NHDFs in the presence or absence of 10 nM OT for 3 days and continuously subcultured for 12 days. Subsequently, various age‐associated signs of senescence including decreased proliferation rate, elevated p16 and p21 level, and positivity for senescence‐associated β‐galactosidase (SA‐β‐Gal) expression were examined.

Results

We found that OT suppressed senescence‐associated secretory phenotype (SASP)‐induced senescence in NHDFs and its effect depended on the age of donor's NHDFs. The inhibitory effects of OT required the OT receptor‐mediated extracellular signal‐regulated kinase (ERK)/nuclear factor‐erythroid 2‐related factor 2 (Nrf2) signalling. Age‐dependent anti‐senescence effects of OT is closely related to the OT receptor (OTXR) gene hypermethylation.

Conclusions

Our findings bring to light OT role as a new clinical strategy for the prevention of skin ageing.

This article is protected by copyright. All rights reserved.

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Post‐zygotic mosaicism in a woman with Goltz syndrome mimics segmental angioma serpiginosum

Abstract

A 30‐year‐old Caucasian woman with no relevant medical history or family history presented to dermatology with a benign fibrous papule on her nose and was incidentally found to have an unusual rash on her legs. It had developed after birth, was itchy and aggravated by hot weather. She had no previous miscarriages and had a healthy 2‐year‐old daughter. On examination there were red, scaly plaques and areas of dermal atrophy in a blaschkoid distribution on the lower left leg (Fig 1a) and a linear punctate eruption over the right inner thigh (Fig 1b).

This article is protected by copyright. All rights reserved.

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LEKTI domains 6, 7 and 8+9 serve as substrates for transglutaminase 1: implications for targeted therapy of Netherton syndrome

Abstract

Background

Transglutaminase 1 (TG1) plays a key role in the formation of the cornified envelope and thus in the maintenance of the epidermal barrier. Patients with Netherton syndrome (LEKTI deficiency) have an increased activity of TG1 as well as of serin proteases.

Objective

We wondered whether there is a functional biochemical link between TG1 and LEKTI and whether LEKTI domains could possibly serve as substrates for TG1.

Methods

We analysed the protein sequence of LEKTI for possible TG1 recognition sites using bioinformatics. Synthetic peptides and recombinant LEKTI domains D6, D7, D8+9 were examined in‐vitro and in‐situ for possible substrate specificity. The recombinant LEKTI domains were studied for inhibitory activity in a KLK5 activity test.

Results

We identified possible TG1 consensus sequences in LEKTI domains D6, D7, D8+9 pointing to a novel biological link between these two proteins. Indeed, synthesized short peptides from these consensus sequences were incorporated into the TG1 activity zone of the epidermis. In‐vitro the recombinant entire domains of LEKTI showed substrate‐specificity for TG1, which could again be confirmed in‐situ. The inhibitory activity of the recombinant LEKTI domains was confirmed by a KLK5 inhibition test. The strongest inhibition was observed for domain D8+D9.

Conclusion

There are specific domains of LEKTI, which are recognized and processed by transglutaminase 1. LEKTI domains D6, D7 and D8+9 contribute to the formation and protection of the cornified envelope. These results impact the development of protein replacement therapy approaches for Netherton syndrome.

This article is protected by copyright. All rights reserved.

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Erythematotelangiectatic rosacea may be associated with a subclinical stage of demodicosis. A case control study

Summary

Background

Facial densities of Demodex mite have been observed to be greater in patients with demodicosis and papulopustular rosacea than in healthy control patients. In patients with erythematotelangiectatic rosacea (ETR), this density has been observed to be similar to or greater than that of healthy controls. Erythema and telangiectasia, characteristics of ETR, are often observed among patients with pityriasis folliculorum, a discreet demodicosis, suggesting a possible link between these conditions.

Objectives

To compare the facial Demodex densities of patients with clinical ETR and patients with healthy skin, demodicosis, rosacea with papulopustules, and other dermatoses.

Methods

In this retrospective study, we recorded Demodex densities measured using two consecutive standardised skin biopsies (SSSB1 and SSSB2) in 23 patients with ETR, 20 healthy control patients, 590 patients with demodicosis, 254 with rosacea with papulopustules, and 180 with other facial dermatoses.

Results

Patients with ETR had higher Demodex densities than did the healthy controls (mean ±SEM, SSSB1: 15.7±6.3 vs. 1.8±1.1 Demodex(D)/cm² [p=0.042]; SSSB2: 38.0±13.7 vs. 5.1±2.1 D/cm² [p=0.026]) and patients with other dermatoses (SSSB1: 0.4±0.1D/cm² [p=0.004]; SSSB2: 1.3±0.3 D/cm² [p=0.004]), but lower than patients with demodicosis (SSSB1: 82.7±4.2D/cm² [p=0.008]; SSSB2: 172.2±7.7 D/cm² [p=0.001]) or rosacea with papulopustules (SSSB1: 86.6±7.3 D/cm² [p=0.027]; SSSB2: 197.0±12.1 D/cm² [p=0.002]).

Conclusions

ETR may be associated with non‐visible Demodex proliferation, possibly corresponding to a subclinical stage of demodicosis. Dermatologists should be aware of this potential association and look for subclinical demodicosis in patients with ETR, so that topical acaricidal treatment can be offered if Demodex density is high.

This article is protected by copyright. All rights reserved.

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Digitally reconstructed top‐down view images provides intuitive understanding of correlation between dermoscopy and histopathology: A good educational tool

Abstract

Dermoscopy is an optical technique, which enables us to observe the fine structures especially in melanocytic skin lesions. In the dermoscopic structures of melanocytic lesions, including nevocellular nevus and melanoma, 1) pigment network, 2) dots and globules, and 3) streaks are main components. The irregularity of these structures helps us differentiate benign nevi from malignant melanoma.

This article is protected by copyright. All rights reserved.

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Open‐label, Investigator‐Initiated, Single Site Exploratory Trial Evaluating Secukinumab, an anti IL17A monoclonal antibody, for Patients with Moderate‐to‐Severe Hidradenitis Suppurativa

Abstract

Hidradenitis Suppurativa (HS) is a chronic inflammatory skin disease of the apocrine gland‐rich intertriginous areas.¹ HS lesions have an elevated Th17 immune response, and it is often challenging to treat patients, with existing therapies having limited efficacy.^2,3 We sought to investigate the role of secukinumab, a human monoclonal antibody that inhibits Interleukin‐17A, in HS treatment.

This article is protected by copyright. All rights reserved.

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Clinical presentation, therapeutic approach and outcome of primary cutaneous marginal zone B‐cell lymphoma presenting as AL amyloidoma of the skin

Abstract

Primary cutaneous marginal zone B‐cell lymphoma (PCMZBCL) usually presents with erythematous papules, plaques and nodules. It is characterized by an indolent proliferation of marginal zone, plasmacytoid and plasma cells with an immunoglobulin light chain restriction. Local radiotherapy, topical or intralesional corticosteroids and surgery are effective therapeutic options in localized disease.

This article is protected by copyright. All rights reserved.

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Outcomes of surgical treatment for hemangiomas

Abstract

Objective

To quantify complications and rates of adverse events associated with surgical excision of hemangiomas in children using a national surgical database.

Data source

Pediatric American College of Surgeons (ACS) National Surgical Quality Improvement Program^® (ACS NSQIP^®‐pediatric), years 2012‐2016.

Methods

Subjects included children under 18 years with a postoperative diagnosis of International Classification of Diseases (ICD), 9th revision code: 228.00 and 228.01, or ICD 10 codes D18.00 and D18.01—hemangioma, any site and hemangioma, of skin and subcutaneous tissue.

Results

A total of 1180 patients were included. The median age was 3.2 years (interquartile range [IQR] 1.2 to 6.4 years old). No occurrences of deep incisional surgical site infection, nerve injury, mortality, sepsis, septic shock, or blood stream infections were noted. In multivariate analysis, age ≤ 3 years and advanced American Society of Anesthesiologists class were significant predictors of adverse events (P = 0.035 and 0.001, respectively).

Conclusions

For children with infantile hemangioma who fail to respond or have an incomplete response to medical therapy, surgical resection may be a relatively safe treatment alternative. Children older than 3 years of age with hemangiomas had less surgical adverse events than younger children. Overall, however, the surgical complications rates were low and deemed relatively minor.

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